Calendar No. 2
109th CONGRESS
1st Session
S. 288
To extend Federal funding for operation of State high risk health
insurance pools.
IN THE SENATE OF THE UNITED STATES
Mr. GREGG (for himself, Mr. BAUCUS, Mr. DEWINE, Mr. BINGAMAN, Mr. ROBERTS,
Mr. LIEBERMAN, Mr. COCHRAN, and Mr. ENZI) introduced the following bill; which
was read twice and referred to the Committee on Health, Education, Labor,
and Pensions
February 10, 2005
Reported by Mr. ENZI, with an amendment
[Strike out all after the enacting clause and insert the part printed in
italic]
A BILL
To extend Federal funding for operation of State high risk health
insurance pools.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
[Struck out->] SECTION 1. SHORT TITLE. [<-Struck out]
[Struck out->] This Act may be cited as the `State High Risk Pool
Funding Extension Act of 2005'. [<-Struck out]
[Struck out->] SEC. 2. EXTENSION OF FUNDING FOR OPERATION OF STATE
HIGH RISK HEALTH INSURANCE POOLS. [<-Struck out]
[Struck out->] (a) Extension of Seed Grants- Section 2745 of the
Public Health Service Act (42 U.S.C. 300gg-45) is amended-- [<-Struck
out]
[Struck out->] (1) in subsection (a), in the subsection heading
by inserting `Extension of' before `Seed'; and [<-Struck out]
[Struck out->] (2) in subsection (c)(1), by striking `$20,000,000'
and all that follows through `2003' and inserting `$15,000,000 for the period
of fiscal years 2005 and 2006'. [<-Struck out]
[Struck out->] (b) Funds for Operations- Section 2745 of the Public
Health Service Act (42 U.S.C. 300gg-45) is amended-- [<-Struck out]
[Struck out->] (1) in subsection (b)-- [<-Struck out]
[Struck out->] (A) in the subsection heading by striking `Matching';
and [<-Struck out]
[Struck out->] (B) by striking paragraph (2) and inserting the
following: [<-Struck out]
[Struck out->] `(2) ALLOTMENT- The amounts appropriated under subsection
(c)(2) for a fiscal year shall be made available to the States (or the entities
that operate the high risk pool under applicable State law) as follows:
[<-Struck out]
[Struck out->] `(A) An amount equal to 50 percent of the appropriated
amount for the fiscal year shall be allocated in equal amounts among each
eligible State that applies for assistance under this subsection. [<-Struck
out]
[Struck out->] `(B) An amount equal to 25 percent of the appropriated
amount for the fiscal year shall be allocated among the States so that
the amount provided to a State bears the same ratio to such available
amount as the number of uninsured individuals in the State bears to the
total number of uninsured individuals in all States (as determined by
the Secretary). [<-Struck out]
[Struck out->] `(C) An amount equal to 25 percent of the appropriated
amount for the fiscal year shall be allocated among the States so that
the amount provided to a State bears the same ratio to such available
amount as the number of individuals enrolled in health care coverage through
the qualified high risk pool of the State bears to the total number of
individuals so enrolled through qualified high risk pools in all States
(as determined by the Secretary).'; and [<-Struck out]
[Struck out->] (2) in subsection (c)(2), by striking `$40,000,000'
and all that follows through the period and inserting `$75,000,000 for each
of fiscal years 2005 through 2009 to make allotments under subsection (b)(2).'.
[<-Struck out]
[Struck out->] (c) Definitions- Section 2745 of the Public Health
Service Act (42 U.S.C. 300gg-45) is amended-- [<-Struck out]
[Struck out->] (1) in subsection (d), by inserting after `2744(c)(2)'
the following: `, except that with respect to subparagraph (A) of such section
a State may elect to provide for the enrollment of eligible individuals
through an acceptable alternative mechanism,'; and [<-Struck out]
[Struck out->] (2) by adding at the end the following: [<-Struck
out]
[Struck out->] `(e) Standard Risk Rate- In subsection (b)(1)(A),
the term `standard risk rate' means a rate-- [<-Struck out]
[Struck out->] `(1) determined under the State high risk pool by
considering the premium rates charged by other health insurers offering
health insurance coverage to individuals in the insurance market served;
[<-Struck out]
[Struck out->] `(2) that is established using reasonable actuarial
techniques; and [<-Struck out]
[Struck out->] `(3) that reflects anticipated claims experience
and expenses for the coverage involved.'. [<-Struck out]
SECTION 1. SHORT TITLE.
This Act may be cited as the `State High Risk Pool Funding Extension Act
of 2005'.
SEC. 2. EXTENSION OF FUNDING FOR OPERATION OF STATE HIGH RISK HEALTH
INSURANCE POOLS.
Section 2745 of the Public Health Service Act (42 U.S.C. 300gg-45) is
amended to read as follows:
`SEC. 2745. PROMOTION OF QUALIFIED HIGH RISK POOLS.
`(a) EXTENSION OF SEED GRANTS TO STATES- The Secretary shall provide from
the funds appropriated under subsection (d)(1)(A) a grant of up to $1,000,000
to each State that has not created a qualified high risk pool as of the date
of enactment of this section for the State's costs of creation and initial
operation of such a pool.
`(b) GRANTS FOR OPERATIONAL LOSSES-
`(1) IN GENERAL- In the case of a State that has established a qualified
high risk pool that--
`(A) restricts premiums charged under the pool to no more than 150
percent of the premium for applicable standard risk rates;
`(B) offers a choice of two or more coverage options through the pool;
and
`(C) has in effect a mechanism reasonably designed to ensure continued
funding of losses incurred by the State after the end of fiscal year 2004
in connection with operation of the pool;
the Secretary shall provide, from the funds appropriated under subsection
(d)(1)(B)(i) and allotted to the State under paragraph (2), a grant for
the losses incurred by the State in connection with the operation of the
pool.
`(2) ALLOTMENT- The amounts appropriated under subsection (d)(1)(B)(i)
for a fiscal year shall be made available to the States (or the entities
that operate the high risk pool under applicable State law) as follows:
`(A) An amount equal to 50 percent of the appropriated amount for
the fiscal year shall be allocated in equal amounts among each eligible
State that applies for assistance under this subsection.
`(B) An amount equal to 25 percent of the appropriated amount for
the fiscal year shall be allocated among the States so that the amount
provided to a State bears the same ratio to such available amount as the
number of uninsured individuals in the State bears to the total number
of uninsured individuals in all States (as determined by the Secretary).
`(C) An amount equal to 25 percent of the appropriated amount for
the fiscal year shall be allocated among the States so that the amount
provided to a State bears the same ratio to such available amount as the
number of individuals enrolled in health care coverage through the qualified
high risk pool of the State bears to the total number of individuals so
enrolled through qualified high risk pools in all States (as determined
by the Secretary).
`(c) BONUS GRANTS FOR SUPPLEMENTAL CONSUMER BENEFITS-
`(1) IN GENERAL- In the case of a State that has established a qualified
high risk pool, the Secretary shall provide, from the funds appropriated
under subsection (d)(1)(B)(ii) and allotted to the State under paragraph
(3), a grant to be used to provide supplemental consumer benefits to enrollees
or potential enrollees (or defined subsets of such enrollees or potential
enrollees) in qualified high risk pools.
`(2) BENEFITS- A State shall use amounts received under a grant under
this subsection to provide one or more of the following benefits:
`(A) Low-income premium subsidies.
`(B) A reduction in premium trends, actual premiums, or other cost-sharing
requirements.
`(C) An expansion or broadening of the pool of individuals eligible
for coverage, including eliminating waiting lists, increasing enrollment
caps, or providing flexibility in enrollment rules.
`(D) Less stringent rules, or additional waiver authority, with respect
to coverage of pre-existing conditions.
`(F) The establishment of disease management programs.
`(3) LIMITATION- In allotting amounts under this subsection, the Secretary
shall ensure that no State receives an amount that exceeds 10 percent of
the amount appropriated for the fiscal year involved under subsection (d)(1)(B)(ii).
`(4) RULE OF CONSTRUCTION- Nothing in this subsection shall be construed
to prohibit States that, on the date of enactment of the State High Risk
Pool Funding Extension Act of 2005, are in the process of implementing programs
to provide benefits of the type described in paragraph (2), from being eligible
for a grant under this subsection.
`(1) IN GENERAL- Out of any money in the Treasury of the United States
not otherwise appropriated, there are authorized and appropriated--
`(A) $15,000,000 for the period of fiscal years 2005 and 2006 to carry
out subsection (a); and
`(B) $75,000,000 for each of fiscal years 2005 through 2009, of which--
`(i) two-thirds of the amount appropriated for a fiscal year shall
be made available for allotments under subsection (b)(2); and
`(ii) one-third of the amount appropriated for a fiscal year shall
be made available for allotments under subsection (c)(2).
`(2) AVAILABILITY- Funds appropriated under this subsection for a fiscal
year shall remain available for obligation through the end of the following
fiscal year.
`(3) REALLOTMENT- If, on June 30 of each fiscal year, the Secretary
determines that all amounts appropriated under paragraph (1)(B)(ii) for
the fiscal year are not allotted, such remaining amounts shall be allotted
among States receiving grants under subsection (b) for the fiscal year in
amounts determined appropriate by the Secretary.
`(4) NO ENTITLEMENT- Nothing in this section shall be construed as providing
a State with an entitlement to a grant under this section.
`(e) APPLICATIONS- To be eligible for a grant under this section, a State
shall submit to the Secretary an application at such time, in such manner,
and containing such information as the Secretary may require.
`(f) DEFINITIONS- In this section:
`(1) QUALIFIED HIGH RISK POOL-
`(A) IN GENERAL- The term `qualified high risk pool' has the meaning
given such term in section 2744(c)(2), except that with respect to subparagraph
(A) of such section a State may elect to provide for the enrollment of
eligible individuals through--
`(i) a combination of a qualified high risk pool and an acceptable
alternative mechanism; or
`(ii) other health insurance coverage described in subparagraph
(B).
`(B) HEALTH INSURANCE COVERAGE- Health insurance coverage described
in this subparagraph is individual health insurance coverage--
`(i) that meets the requirements of section 2741;
`(ii) that is subject to limits on the rates charged to individuals;
`(iii) that is available to all individuals eligible for health
insurance coverage under this title who are not able to participate
in a qualified high risk pool; and
`(iv) the defined rate limit of which does not exceed the limit
allowed for a qualified risk pool that is otherwise eligible to receive
assistance under a grant under this section.
`(C) OTHER COVERAGE- In addition to coverage described in subparagraph
(B), a State may provide for the offering of health insurance coverage
that provides first dollar coverage, limits on cost-sharing, and comprehensive
medical, hospital and surgical coverage, if the limits on rates for such
coverage do not exceed 125 percent of the limit described in subparagraph
(B)(iv).
`(2) STANDARD RISK RATE- The term `standard risk rate' means a rate--
`(A) determined under the State high risk pool by considering the
premium rates charged by other health insurers offering health insurance
coverage to individuals in the insurance market served;
`(B) that is established using reasonable actuarial techniques; and
`(C) that reflects anticipated claims experience and expenses for
the coverage involved.
`(3) STATE- The term `State' means any of the 50 States and the District
of Columbia.'.
Calendar No. 2
109th CONGRESS
1st Session
S. 288
A BILL
To extend Federal funding for operation of State high risk health insurance
pools.
February 10, 2005
Reported with an amendment
END
